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Tahoun FAM, Kehela HAG, Nasr DM. Influence of different immediate dentin sealing strategies on bond strength of indirect resin nanoceramic restorations. Eur J Oral Sci 2024; 132:e12983. [PMID: 38497607 DOI: 10.1111/eos.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/27/2024] [Indexed: 03/19/2024]
Abstract
In this study, we evaluated the effect of four different strategies for bonding a CAD/CAM resin nanoceramic restoration (Lava Ultimate, 3M) to the dentin surface using a universal adhesive (Scotch Bond Universal, 3M) and adhesive resin cement (RelyX Ultimate, 3M) on the shear bond strength (SBS) and failure mode. The strategies comprised: (i) immediate sealing, immediate bonding; (ii) immediate sealing, bonding after 2 weeks with provisional restoration; (iii) immediate sealing with flowable resin composite reinforcement and bonding after 2 weeks with provisional restoration; and (iv) no immediate sealing, and bonding after 2 weeks with provisional restoration. After bonding, all the specimens were thermocycled, shear tests were performed using a universal testing machine, and failure modes were determined using stereomicroscope and scanning electron microscopy. The highest mean SBS was recorded with immediate sealing, immediate bonding strategy. Most adhesive failures with exposed dentinal tubules were noted in specimens exposed to bonding after 2 weeks with no immediate sealing, which was associated with the lowest SBS. Mixed failures predominated in all immediate dentin sealing groups. Immediate sealing with universal adhesives improves SBS, particularly in the single-visit approach, which has shown significantly better performance, whereas the provisional phase has a negative effect.
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Affiliation(s)
- Fatma-Alzahraa Mohamed Tahoun
- Division of Operative, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Hany Abdel-Ghafar Kehela
- Division of Operative, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Dina Mohamed Nasr
- Division of Operative, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Bresser RA, Hofsteenge JW, Buijs GJ, van den Breemer CRG, Özcan M, Cune MS, Gresnigt MMM. Partial glass-ceramic posterior restorations with margins beyond or above the cemento-enamel junction: An observational retrospective clinical study. J Prosthodont Res 2024:JPR_D_23_00219. [PMID: 38684406 DOI: 10.2186/jpr.jpr_d_23_00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
PURPOSE This observational retrospective clinical study aimed to investigate the survival and success rates of partial indirect lithium disilicate restorations with margins extending above or beyond the cementoenamel junction (CEJ). METHODS The study included patients who underwent partial indirect lithium disilicate restorations with immediate dentin sealing (IDS) between January 2008 and October 2018. All the restorations were placed in a single general dental practice following a standardized protocol. The impact of various predictive variables on the survival rates was assessed. Moreover, modified United States Public Health Service (USPHS) criteria were used to evaluate the survival quality. RESULTS Totally 1146 partial indirect lithium disilicate restorations in 260 patients were evaluated over an average period of 7.5 years. The cumulative survival and success rates were 97.3% and 95.3%, respectively. Margins extending beyond the cemento-enamel junction did not increase the risk of success or survival failure (P > 0.05). Patients with a high risk of caries, male sex, or non-vital teeth had a significantly higher risk of restoration failure (P < 0.05). Restorations with longer clinical service times exhibited marginally lower clinical quality (P < 0.001). CONCLUSIONS Partial indirect glass-ceramic restorations demonstrated survival and success rates of 97.3% and 95.3%, respectively, over an extended period. However, a higher risk of restoration failure existed in patients with a high caries risk for (pre)molars that had undergone endodontic treatment and in males. In terms of the risk of success or survival failure, comparable results were obtained for the positions of the restoration margin in relation to the cemento-enamel junction.
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Affiliation(s)
- Rijkje A Bresser
- University of Groningen, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry, Groningen, The Netherlands
| | - Jelte W Hofsteenge
- University of Groningen, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry, Groningen, The Netherlands
| | - Gerrit J Buijs
- Buijs Tandartsen, Clinic for General Dentistry, Groningen, The Netherlands
| | - Carline R G van den Breemer
- University of Groningen, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry, Groningen, The Netherlands
| | - Mutlu Özcan
- University of Groningen, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry, Groningen, The Netherlands
- University of Zurich, Center of Dental Medicine, Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Zurich, Switzerland
| | - Marco S Cune
- University of Groningen, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry, Groningen, The Netherlands
- St. Antonius Hospital, Department of Oral Maxillofacial Surgery, Prosthodontics and Special Dental Care, Nieuwegein, The Netherlands
| | - Marco M M Gresnigt
- University of Groningen, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry, Groningen, The Netherlands
- Martini Hospital, Department of Special Dental Care, Groningen, The Netherlands
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Demir N, Genc O, Akkese IB, Malkoc MA, Ozcan M. Bonding Effectiveness of Saliva-Contaminated Monolithic Zirconia Ceramics Using Different Decontamination Protocols. BIOMED RESEARCH INTERNATIONAL 2024; 2024:6670159. [PMID: 38606199 PMCID: PMC11008971 DOI: 10.1155/2024/6670159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 03/07/2024] [Accepted: 03/16/2024] [Indexed: 04/13/2024]
Abstract
Objective This research study investigated the effect of new decontamination protocols on the bonding capacity of saliva-contaminated monolithic zirconia (MZ) ceramics cemented with two different monomer-containing self-adhesive resin cements. Materials and Methods Standardized tooth preparations (4 mm. axial height) were performed for eighty human maxillary premolars under constant water cooling system. Eighty monolithic zirconia crowns (Whitepeaks Supreme Monolith) (n = 8/10 groups) were manufactured by CAD-CAM. Specimens were kept in the artificial saliva at pH = 7.3 for 1 minute at 37°C except control groups. The specimens have not been prealumina blasted and grouped according to cleaning methods and resin cements: control groups (C) (no saliva contamination + GPDM + 4-META (N) (CN) and 10-MDP (M) containing resin cement (CM), alumina blasted (AL) + GPDM + 4-META (ALN) and 10-MDP containing resin cement (ALM), zirconium oxide containing universal cleaning agent (IC) applied + GPDM + 4-META (N) (ICN) and 10-MDP containing resin cement (ICM), pumice (P) applied + GPDM + 4-META (PN) and 10-MDP containing resin cement (PM), and air-water spray (AW) applied + GPDM + 4-META (AWN) and 10-MDP containing resin cement (AWM)). Monobond Plus was applied to all surfaces for 40 seconds before cementation. The thermal cycle was applied at 5,000 cycles after cementation. The crowns were tested in tensile mode at a speed of 1 mm/min. The mode of failure was recorded. SEM examinations were carried out at different magnifications. Data were analyzed using rank-based Kruskal-Wallis and Mann-Whitney tests. Results No significant differences were found between the surface treatments and between the two types of resin cements. Interaction effects between surface treatments and resin cements were found to be significant by two-way ANOVA analysis. ICM group resulted in significantly better bond strength results compared with CN. ICM was found to result in better bond strength results compared with PM. The combination of universal cleaning agent and 10-MDP containing resin cement had significantly the highest cementation bond strength values. The increasing order of mean tensile bond strength values of decontamination protocols was C < AW < P < AL < IC. The mean tensile bond strength of 10-MDP containing resin cement was slightly higher than GPDM + 4-META containing resin cement. Conclusions Universal cleaning agents can be preferred as an efficient cleaning method with 10-MDP-containing cement after saliva contamination for better adhesive bond strength of 4 mm crown preparation height of monolithic zirconia ceramics.
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Affiliation(s)
- Necla Demir
- Selcuk University, Faculty of Dentistry, Department of Prosthodontics, Konya, Türkiye
| | - Ozge Genc
- Selcuk University, Faculty of Dentistry, Department of Prosthodontics, Konya, Türkiye
| | - Ipek Balevi Akkese
- Selcuk University, Faculty of Dentistry, Department of Prosthodontics, Konya, Türkiye
| | - Meral Arslan Malkoc
- Akdeniz University, Faculty of Dentistry, Department of Prosthodontics, Antalya, Türkiye
| | - Mutlu Ozcan
- Clinic for Fixed and Removable Prosthodontics and Dental Materials Science, Center for Dental and Oral Medicine, University of Zurich, Zurich, Switzerland
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Ozer F, Batu Eken Z, Hao J, Tuloglu N, Blatz MB. Effect of Immediate Dentin Sealing on the Bonding Performance of Indirect Restorations: A Systematic Review. Biomimetics (Basel) 2024; 9:182. [PMID: 38534867 DOI: 10.3390/biomimetics9030182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/04/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024] Open
Abstract
The popular immediate dentin sealing (IDS) technique is used to improve the bond strength of indirect restorations. This systematic review assessed whether bond strength is affected by the type of aging conditions, bonding agents, flowable resin composites, impression materials, temporary materials, and/or resin cement used within the IDS procedure. A comprehensive database search of PubMed, Embase, Scopus, Ovid Medline, Web of Sciences, Cochrane Library, Dentistry & Oral Sciences Source, and ProQuest was carried out up to 30 January 2024 without publication year or language limitations. Only in vitro full-texts regarding the effect of IDS on bond strength were included, and the quality of their methods was assessed via a Risk of Bias (RoB) test. In total, 1023 pertinent studies were initially found, and 60 articles were selected for review after screening for the title, abstract, and full texts. IDS application improves the bond strength of indirect restorations to dentin and reduces the negative effects of temporary materials on the bond durability of final indirect restorations. Filled dentin bonding agents or combinations with flowable resin composite are preferred to protect the IDS layer from conditioning procedures.
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Affiliation(s)
- Fusun Ozer
- School of Dental Medicine, Department of Preventive and Restorative Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Zeynep Batu Eken
- Faculty of Dentistry, Department of Restorative Dentistry, Yeditepe University, Istanbul 34728, Turkey
| | - Jessica Hao
- School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nuray Tuloglu
- Faculty of Dentistry, Department of Pediatric Dentistry, University of Eskisehir Osmangazi, Eskisehir 26040, Turkey
| | - Markus B Blatz
- School of Dental Medicine, Department of Preventive and Restorative Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
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Hofsteenge JW, Bresser RA, Buijs GJ, van der Made SA, Özcan M, Cune MS, Gresnigt MM. Clinical performance of bonded partial lithium disilicate restorations: The influence of preparation characteristics on survival and success. J Dent 2024; 142:104828. [PMID: 38159900 DOI: 10.1016/j.jdent.2023.104828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES The aim of this study was to investigate the influence of preparation characteristics on the survival, success, and clinical performance of partial indirect lithium disilicate restorations with immediate dentin sealing. METHODS This retrospective clinical study evaluated partial indirect lithium disilicate restorations placed in conjunction with Immediate Dentin Sealing (IDS) in (pre)molar teeth between March 2018 and May 2021. The restorations were luted using pre-heated composite. The study focused on survival, success, and clinical performance, which was evaluated using the modified United States Public Health Service (USPHS) criteria. Results were analyzed using the Kaplan-Meier estimates, log-rank tests, and Fisher exact tests. RESULTS Partial indirect lithium disilicate restorations (N = 454) were evaluated in 214 patients. The mean evaluation time was 37 months, with a cumulative survival rate of 99.2 % and a cumulative success rate of 97.6 %. Fourteen failures occurred, with endodontic pathology as the predominant failure mode, followed by secondary caries, debonding, and tooth fracture. No statistically significant influence of the preparation variables on survival and success was observed (p > .05). The short-term clinical performance was clinically acceptable in > 90 % of the evaluations. CONCLUSIONS This retrospective study on partial indirect lithium disilicate restorations in conjunction with IDS demonstrates survival and success rates of 99.2 and 96.7 % over a mean evaluation period of 37 months. A marked influence of the studied preparation characteristics on the survival, success and clinical performance of lithium disilicate partial restorations could not be demonstrated. Partial lithium disilicate restorations exhibit good clinical performance in >90 % of the cases. CLINICAL SIGNIFICANCE The results of this study suggest that preparation characteristics had no significant impact on the survival, success, and clinical performance of partial lithium disilicate restorations in conjunction with IDS. Results show good clinical performance and high survival and success rates, regardless of preparation characteristics.
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Affiliation(s)
- Jelte W Hofsteenge
- Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, the Netherlands.
| | - Rijkje A Bresser
- Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, the Netherlands
| | - Gerrit J Buijs
- Private Practice Buijs Tandartsen, Groningen, the Netherlands
| | | | - Mutlu Özcan
- Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, the Netherlands; Center of Dental Medicine, Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Marco S Cune
- Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, the Netherlands; Department of Oral Maxillofacial Surgery, Prosthodontics and Special Dental Care, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Marco Mm Gresnigt
- Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AV 9713, the Netherlands; Department of Special Dental Care, Martini Hospital, Groningen, the Netherlands
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Ding J, Zhu X, Lin Q, Lin L, Yang Z, Zhu S. Effects of Arginine-calcium carbonate pretreatment on the remineralizing and bonding performance of phosphorylated dentin. J Mech Behav Biomed Mater 2023; 140:105718. [PMID: 36774762 DOI: 10.1016/j.jmbbm.2023.105718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES To evaluate the effects of Arginine-calcium carbonate (Arg-CaCO3) paste treatment of phosphorylated dentin on remineralizing and bonding performance during direct and indirect restorations under pulpal pressure. METHODS Under simulated pulpal pressure, dentin of healthy third molars were abraded and acid etched for 15s, then randomly divided into 4 groups: negative control group; Arg-CaCO3 group (1min); 2.5% Sodium trimetaphosphate (STMP) group (3min); S-A group, 2.5% STMP + Arg-CaCO3. After 24h, remineralization and dentin tubular occlusion were assessed by Attenuated total reflection fourier transform infrared spectroscopy (ATR-FTIR), Micro-Raman spectroscopy, Vickers hardness, Field-emission scanning electron microscope (FESEM) and Energy X-ray dispersive spectrometer (EDS). The liquid environment was the simulated body fluid (SBF) permeated from dentin tubules due to pulpal pressure. Stick specimens prepared with self-etch dentin adhesive were tested for microtensile bond strength (μTBS) and interfacial silver nanoleakage on both immediate direct restoration and indirect restoration with a 7-day temporary period. Data were analyzed by the Kruskal-Wallis test, Mann-Whitney test, Welch ANOVA or one-way ANOVA and Tukey post hoc test (p < 0.05). RESULTS The pretreatment of 2.5% STMP with Arg-CaCO3 significantly increased relative mineral content by ATR-FTIR, Raman and FESEM-EDS, simultaneously enhancing dentin tubular occlusion (%) and mechanical property to the most considerable extent. Furthermore, the pretreatment significantly promoted the μTBS of indirect restoration and reduced nanoleakage after 7 days. CONCLUSIONS The application of Arg-CaCO3 paste on phosphorylated dentin could improve intra- and extra-tubular mineralization and the stability of adhesion interface. CLINICAL RELEVANCE Without exceeding the amount of conventional tooth preparation, combining 2.5% STMP with Arg-CaCO3 paste before the self-etch bonding system might be a promising clinical strategy to relieve dentin hypersensitivity and strengthen bonding performance efficiently and conveniently.
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Affiliation(s)
- Jingyu Ding
- Department of Prosthetic Dentistry, School and Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Xuanyan Zhu
- Department of Prosthetic Dentistry, School and Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Qi Lin
- Department of Prosthetic Dentistry, School and Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Lingkang Lin
- Department of Prosthetic Dentistry, School and Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Zhengyuan Yang
- Department of Prosthetic Dentistry, School and Hospital of Stomatology, Jilin University, Changchun, PR China
| | - Song Zhu
- Department of Prosthetic Dentistry, School and Hospital of Stomatology, Jilin University, Changchun, PR China.
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Ding J, Jin Y, Feng S, Chen H, Hou Y, Zhu S. Effect of temporary cements and their removal methods on the bond strength of indirect restoration: a systematic review and meta-analysis. Clin Oral Investig 2023; 27:15-30. [PMID: 36422719 PMCID: PMC9877054 DOI: 10.1007/s00784-022-04790-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/13/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES For a conventional indirect restoration, temporary cementation inevitably contaminated collapsed dentin collagen. The purpose of this review was to evaluate the optimal strategy for minimizing its negative effects. MATERIAL AND METHODS Databases such as PubMed, Web of Science, EMBASE, and the Cochrane Library were searched for in vitro studies, involving the influence of immediate dentin sealing (IDS), different temporary cements, and their removal strategies on dentin bond strength. The meta-analysis used the inverse variance method with effect method of the standardized mean difference and statistical significance at p ≤ 0.05. The I2 value and the Q-test were used to assess the heterogeneity. RESULTS A total of 14 in vitro trials were subjected to the meta-analysis. Within the study's limitations, we assumed that IDS eliminated the negative effects of temporary bonding, achieving the comparable immediate bond strength with the control (p = 0.46). In contrast, under delayed dentin sealing (DDS), temporary cementation statistically decreased bond strength (p = 0.002). Compared with resin-based and non-eugenol zinc oxide cements, polycarboxylate and calcium hydroxide cements performed better on bond strength with no statistical difference from the control group (p > 0.05). Among the removal methods of temporary cements, the Al2O3 abrasion restored the decreased bond strength (p = 0.07) and performed better than hand instruments alone (p = 0.04), while pumice removal slightly reduced the bond strength in contrast with the control group (p = 0.05, 95% CI = - 1.62 to 0). CONCLUSIONS The choices of IDS, polycarboxylate and calcium hydroxide temporary cements, Al2O3 abrasion removal method were feasible and efficient to enhance the bond strength. CLINICAL RELEVANCE It is worthwhile applying IDS technique, polycarboxylate and calcium hydroxide temporary cements during indirect restoration. The Al2O3 abrasion of cleaning dentin can minimize the negative effects of temporary cement.
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Affiliation(s)
- Jingyu Ding
- Department of Prosthodontics, Hospital of Stomatology, Jilin University, 1500 Qinghua Road, Chaoyang District, Changchun, 130012 Jilin China
| | - Yifu Jin
- Department of Prosthodontics, Hospital of Stomatology, Jilin University, 1500 Qinghua Road, Chaoyang District, Changchun, 130012 Jilin China
| | - Shanshan Feng
- Department of Prosthodontics, Hospital of Stomatology, Jilin University, 1500 Qinghua Road, Chaoyang District, Changchun, 130012 Jilin China
| | - Huan Chen
- Department of Prosthodontics, Hospital of Stomatology, Jilin University, 1500 Qinghua Road, Chaoyang District, Changchun, 130012 Jilin China
| | - Yanyan Hou
- Department of Prosthodontics, Hospital of Stomatology, Jilin University, 1500 Qinghua Road, Chaoyang District, Changchun, 130012 Jilin China
| | - Song Zhu
- Department of Prosthodontics, Hospital of Stomatology, Jilin University, 1500 Qinghua Road, Chaoyang District, Changchun, 130012 Jilin China
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Varadan P, Balaji L, Manaswini DY, Rajan RM. Reinforced Immediate Dentin Sealing vs Conventional Immediate Dentin Sealing on Adhesive Behavior of Indirect Restorations: A Systematic Review. J Contemp Dent Pract 2022; 23:1066-1075. [PMID: 37073921 DOI: 10.5005/jp-journals-10024-3415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
AIM The aim of this systematic review is to compare the bonding performance of indirect restoration with the reinforced immediate dentin sealing (IDS) method as opposed to the conventional IDS method. MATERIALS AND METHODS A literature search was conducted in PubMed, Cochrane, and EBSCOHost up to January 31st 2022, accompanied by a hand search in Google Scholar. Inclusion criteria involved studies comparing conventional IDS and reinforced IDS protocol and evaluating various parameters influencing the bonding performance, such as type of indirect restoration, etching protocol, cavity design, tooth surface preparation, method of oral cavity simulation, and processing after luting. The quality of six included studies was appraised using CRIS guidelines. RESULTS A total of 29 publications was identified, and 6 of them fulfilled the inclusion criteria. All of the included studies were in vitro studies. The predetermined data were independently extracted and evaluated by four reviewers. It was observed that most of the studies showed an improvement in bond strength with reinforced IDS when compared with conventional IDS. Also, etch-and-rinse and 2-step self-etch adhesive protocols have shown better bonding performance than universal adhesive systems. CONCLUSION Reinforced IDS has similar or better bond strength to that of conventional IDS strategies. The need for prospective studies is highlighted. The future clinical studies for immediate dentin sealing ought to be reported in a uniform and methodological way. CLINICAL SIGNIFICANCE Application of an additional layer of low-viscosity resin composite provides a thicker adhesive layer, prevents re-exposure of dentin during the final restoration, and allows a smoother preparation in lesser clinical chair time and eliminates any possible undercuts. Thus, reinforced IDS has shown to result in better preservation of the dentinal seal than IDS technique.
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Affiliation(s)
- Preethi Varadan
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Lakshmi Balaji
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India, Phone: +91 9841049310, e-mail:
| | - D Yaso Manaswini
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
| | - R Mathan Rajan
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India
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Teche FP, Valenzuela EBS, Tavares JG, Oliveira EWCD, Bittencourt HR, Burnett Júnior LH, Spohr AM. Immediate dentin sealing influences the fracture strength of ultrathin occlusal veneers made of a polymer-infiltrated ceramic network. J Mech Behav Biomed Mater 2022; 133:105331. [DOI: 10.1016/j.jmbbm.2022.105331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/12/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
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Batista J, Leite MM, Sabag MF, Lopes LG, Torres ÉM. Influence of the Flowable Resin Layer on Bond Strength Between Resin Cement and a Universal Adhesive Applied in the Immediate Dentin-sealing Technique. Oper Dent 2022; 47:403-411. [PMID: 35917239 DOI: 10.2341/21-050-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The present study evaluated the influence of a flowable resin layer on bond strength between resin cement and a universal adhesive applied using an immediate dentin sealing (IDS) technique. METHODS AND MATERIALS Coronary portions of bovine teeth were randomly divided into six groups (n=15). In the IDS.U group, the exposed dentin was immediately sealed with the Single Bond Universal adhesive (3M ESPE) following the self-etching protocol. In the IDS.UF group, a layer of Filtek Z350 (3M ESPE) flow resin was applied over the universal adhesive. In the DDS (control) group, the dentin was kept "fresh" and delayed dentin sealing was performed. After 24 hours in distilled water at 37°C, dentin surfaces were treated with pumice, phosphoric acid, and the application of the universal adhesive in the IDS.U and IDS. UF groups. The DDS group was treated with pumice and the universal adhesive was applied. The samples received cylinders of resin cement Rely X Ultimate (3M ESPE) made with the aid of starch tubes of 0.96 mm in diameter and 2 mm in length. They were submitted to the microshear bond strength test (μSBS) at 0.5 mm/min, after 24 hours (T1) and 3 months (T2). The fracture areas were evaluated qualitatively using a DSM 300 microscope (KOZO) with 45× magnification and classified as: adhesive, cohesive in cement, cohesive in dentin, or mixed. Samples were analyzed by scanning electron microscopy (SEM). The data were compared statistically between groups using the Kruskal-Wallis test, and intra-groups using the Mann-Whitney test (α=0.05). RESULTS There were no significant differences between groups for the bond strength values (p>0.05). The IDS.UF group showed higher values at 3 months, when compared to the values of 24 hours (p<0.001). All groups showed a predominance of adhesive fracture (86.7% to 100%). SEM showed dentinal tubules exposed in the IDS.U and DDS groups; in the IDS.UF group, the tubules were completely sealed. CONCLUSIONS The flow resin can be used on the adhesive when using the IDS technique because it increased the bond strength values after 3 months and promoted effective sealing of the dentinal tubules.
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Affiliation(s)
- Jmn Batista
- *João Marcos Nascimento Batista, MSc, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - M M Leite
- Murillo Martins Leite, MSc, Postgraduate Program in Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - M F Sabag
- Matheus Fabricante Sabag, DDS, Graduate Program in Dentistry, Federal University of Goiás,Goiânia, Brazil
| | - L G Lopes
- Lawrence Gonzaga Lopes, PhD, School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - É M Torres
- Érica Miranda de Torres, PhD, School of Dentistry, Federal University of Goiás, Goiânia, Brazil
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Immediate Dentin Sealing for Adhesive Cementation of Indirect Restorations: A Systematic Review and Meta-Analysis. Gels 2022; 8:gels8030175. [PMID: 35323288 PMCID: PMC8955250 DOI: 10.3390/gels8030175] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 12/19/2022] Open
Abstract
Immediate dentin sealing (IDS) involves applying an adhesive system to dentin directly after tooth preparation, before impression. This was considered an alternate to delayed dentin sealing (DDS), a technique in which hybridization is performed following the provisional phase and just before the indirect restoration luting procedure. This study aimed to compare the bond strength of restorations to dentin of the IDS and the DDS techniques throughout a systematic review and meta-analysis. The following PICOS framework was used: population, indirect restorations; intervention, IDS; control, DDS; outcomes, bond strength; and study design, in vitro studies. PubMed (MedLine), The Cochrane Library, ISI Web of Science, Scielo, Scopus, and Embase were screened up to January 2022 by two reviewers (L.H. and R.B.). In vitro papers studying the bond strength to human dentin of the IDS technique compared to the DDS technique were considered. Meta-analyses were carried out by using a software program (Review Manager v5.4.1; The Cochrane Collaboration). Comparisons were made by considering the adhesive used for bonding (two-step etch-and-rinse, three step etch-and-rinse, one-step self-etch, two-step self-etch, and universal adhesives). A total of 3717 papers were retrieved in all databases. After full-text assessment, 22 potentially eligible studies were examined for qualitative analysis, leaving a total of 21 articles for the meta-analysis. For the immediate bond strength, regardless of the adhesive strategy used, the IDS technique improved the bond strength of restorations to the dentin (p < 0.001). Taking into account the subgroup analysis, it seems that the use of the IDS technique with a two-step etch-and-rinse or a one-step self-etch adhesive system does not represent any advantage over the DDS technique (p = 0.07, p = 0.15). On the other hand, for the aged bond strength, regardless of the adhesive strategy used, the IDS technique improved the bond strength of restorations to the dentin (p = 0.001). The subgroups analysis shows that this improvement is observed only when a three-step etch-and-rinse adhesive system (p < 0.001) or when a combination of an adhesive system plus a layer of flowable resin (p = 0.01) is used. The in vitro evidence suggests that the use of the IDS technique improves the bond strength of dentin to resin-based restorations regardless of the adhesive strategy used. The use of a three-step etch-and-rinse adhesive system or the combination of an adhesive system plus a layer of flowable resin seems to considerably enhance the bond strength in the long term.
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Kusakabe S, Tsuruta H, Uno M, Burrow MF, Nikaido T. Clinical assessment of resin-coating technique applied to exposed dentin after crown preparation. Dent Mater J 2021; 41:226-229. [PMID: 34759125 DOI: 10.4012/dmj.2021-029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The resin-coating technique, in which exposed dentin surfaces are covered using a thin-film coating material, was approved in the Japanese public health insurance system in December 2019. The purpose of this study was to evaluate clinical cases treated using the resin-coating technique with Hybrid Coat II (HC II) after tooth preparation on vital teeth. A total of 134 cases from patients who visited nine dental clinics were examined from the clinical records. Clinical signs and symptoms of cases before, during, and after treatment and at the time of recall were evaluated. The resin-coating was applied as either a single application with HC II (86.6%) or a combined application of HC II and a flowable resin composite (13.4%). The success rate without any symptoms of sensivity to cold water was 92.5% (124 cases). The current results indicated that the resin-coating with HC II is a reliable treatment for the tooth preparation of vital teeth.
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Affiliation(s)
- Shusuke Kusakabe
- Department of Operative Dentistry, Division of Oral Functional Science and Rehabilitation, School of Dentistry, Asahi University
| | - Hanemi Tsuruta
- Department of Operative Dentistry, Division of Oral Functional Science and Rehabilitation, School of Dentistry, Asahi University
| | - Mitsunori Uno
- Department of Prosthodontics, Division of Oral Functional Sciences and Rehabilitation, School of Dentistry, Asahi University
| | - Michael F Burrow
- Restorative Dental Sciences, Faculty of Dentistry, University of Hong Kong
| | - Toru Nikaido
- Department of Operative Dentistry, Division of Oral Functional Science and Rehabilitation, School of Dentistry, Asahi University
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Elbishari H, Elsubeihi ES, Alkhoujah T, Elsubeihi HE. Substantial in-vitro and emerging clinical evidence supporting immediate dentin sealing. JAPANESE DENTAL SCIENCE REVIEW 2021; 57:101-110. [PMID: 34354787 PMCID: PMC8322125 DOI: 10.1016/j.jdsr.2021.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/26/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023] Open
Abstract
The application of resin adhesive to freshly cut dentin after teeth preparation, the so-called immediate dentin sealing (IDS) has been suggested as an alternative to the delayed dentin sealing (DDS), a technique in which resin adhesive is applied just before final bonding of indirect restorations. The aim of this review is to demonstrate the evidence of the claimed advantages made by the proponents of IDS technique. The results of this review revealed substantial in-vitro evidence supporting the IDS benefits including improved bond strength, reduced dentin permeability, improved restorations’ adaptation, and increased fracture strength of the restorations. Clinical studies have shown that IDS improves survival of ceramic laminate veneers bonded to prepared teeth with increased exposure of dentin. Moreover, it has been shown that IDS reduces post-cementation hypersensitivity in full coverage restorations, which is characterized by exposure of a large number of dentinal tubules. The selection of filled resin adhesive that is capable of producing thick adhesive layer appears to contribute to the success of the technique. Furthermore, careful management of the oxygen inhibition layer before conventional impression making and proper cleaning of the residual temporary cement used with provisional restorations appears to affect the outcome of the restorations.
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Affiliation(s)
- Haitham Elbishari
- Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine & Health Sciences, P.O. Box 505055, Dubai, United Arab Emirates
| | | | - Taif Alkhoujah
- Ajman University, P.O. Box 346, Ajman, United Arab Emirates
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Samartzi TK, Papalexopoulos D, Sarafianou A, Kourtis S. Immediate Dentin Sealing: A Literature Review. Clin Cosmet Investig Dent 2021; 13:233-256. [PMID: 34188553 PMCID: PMC8232880 DOI: 10.2147/ccide.s307939] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/20/2021] [Indexed: 02/04/2023] Open
Abstract
Purpose The immediate application of a dentin-bonding agent after tooth preparation and before impression-taking (immediate dentin sealing [IDS]) has been suggested to provide several advantages concerning bacterial microleakage, hypersensitivity, and bonding quality. We reviewed the literature and clarified certain aspects related to each step of IDS application. Materials and Methods The search strategy comprised an electronic research in MEDLINE, Cochrane, Ovid and Scopus for studies published from January 1990 to December 2020 regarding the IDS technique and including both in vitro and clinical studies. Results After exclusion of irrelevant or duplicate articles, 88 articles focusing on aspects of the IDS technique were assessed. IDS seems to be advantageous with regard to bond strength, gap formation, bacterial microleakage, and dentin hypersensitivity. However, issues arising from interaction with impression materials, the provisional phase, and conditioning methods before cementation require further investigation. Conclusion There are no documented reasons preventing clinicians applying IDS in their everyday practice. On the contrary, the presented technique seems to be beneficial in certain aspects regarding indirect restorations.
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Affiliation(s)
| | | | - Aspasia Sarafianou
- Department of Prosthodontics, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Kourtis
- Department of Prosthodontics, National and Kapodistrian University of Athens, Athens, Greece
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Effect of Two Immediate Dentin Sealing Approaches on Bond Strength of Lava™ CAD/CAM Indirect Restoration. MATERIALS 2021; 14:ma14071629. [PMID: 33810529 PMCID: PMC8036871 DOI: 10.3390/ma14071629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022]
Abstract
The objective of this work was to compare the micro-tensile bond strength (µTBS) of CAD/CAM (Computer-Aided Design/ Computer-Aided Manufacturing) specimens cemented with different pairing of adhesives and resin-cements using two Immediate Dentin Dealing (IDS) approaches in comparison with Delay Dentin Sealing (DDS). Coronal dentin from 108 molars were divided into nine groups (n = 12) depending on the adhesive/resin-cement (A-C) assigned. Lava™ Ultimate (4 × 10 × 10 mm) was cemented according to different strategies: IDS1(cementation after dentin sealing), DDS (dentin sealing and cementation at 2-weeks), IDS2 (immediate dentin sealing and cementation at 2-weeks). Samples were sectioned and tested until failure to determine the µTBS. Failure mode was categorized as dentin/cement (DC), at Lava™ Ultimate/cement (LC) and hybrid (H). Kruskal–Wallis and Mann–Whitney U tests and influence of the type of failure on the µTBS by survival analysis with competing risk was explored. Mostly, µTBS values were equal or higher in IDS2 than DDS. In general, A-Cs that showed higher µTBS, have high percentages of LC failure. Survival analysis with competing risk between DC + H and LC values showed that some A-Cs would significantly increase the µTBS values for IDS2. A-Cs with the highest adhesion values showed a high percentage of fractures at the LC interface, suggesting that the adhesion at the adhesive/dentin interface would be higher.
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de Carvalho MA, Lazari-Carvalho PC, Polonial IF, de Souza JB, Magne P. Significance of immediate dentin sealing and flowable resin coating reinforcement for unfilled/lightly filled adhesive systems. J ESTHET RESTOR DENT 2021; 33:88-98. [PMID: 33404184 DOI: 10.1111/jerd.12700] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/14/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Immediate dentin sealing implies applying an adhesive system to dentin directly after tooth preparation, before impression. The technique is universal (inlays, onlays, veneers, crowns) and well documented clinically and experimentally. Different types of dentin bonding agents (DBAs) are available on the market. Major differences lie in the thickness of the hybrid layer and overlaying adhesive resin (filled vs. unfilled/lightly filled adhesives). OBJECTIVE The objective of this work is to provide precise clinical instructions and present new experimental data about the bond strength of five DBAs (Optibond FL, Scotchbond MP, Single Bond Plus, Clearfil SE Bond, and Scotchbond Universal) used conventionally (dentin sealed at the time of restoration delivery) or with immediate dentin sealing, as well as with an additional flowable resin coating. METHODS Seventy-five human molars were selected, restored/tested according the microtensile bond strength method. Fifteen groups (n=5) were obtained from the combination of the five DBAs and three application modes: delayed dentin sealing, immediate dentin sealing and immediate dentin sealing with flowable resin coating. RESULTS It appears that immediate dentin sealing was confirmed to significantly improve the bond strength of all tested adhesives. The use of a flowable resin coating reinforcement after immediate dentin sealing increased the microtensile bond strength of all unfilled/lightly filled adhesives (from 233% of increase for ScotchBond MP, up to 560% for Clearfil SE Bond) and maintained the performance of the 3-step golden standard adhesive. Optibond FL used with (52.51 MPa) or without (54.75 MPa) additional flowable resin coating and Clearfil SE Bond (45.64 MPa) used with flowable resin coating provided the best results. CLINICAL SIGNIFICANCE The original immediate dentin sealing (IDS) technique implies the use of a filled DBA. With unfilled/lightly filled adhesives, it is suggested to reinforce IDS with an additional flowable resin coating. This seems especially paramount to the performance of simplified adhesive systems to protect the thin bonding interface from oxygen inhibition and preserve IDS layer during predelivery cleaning of the preparation. The clinical reinforcement of unfilled/lightly filled IDS with flowable resin composite is encouraged for more predictable bonding.
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Affiliation(s)
| | | | - Isabella Fonseca Polonial
- Department of Prevention and Oral Rehabilitation, School of Dentistry, University of Goiás, Goiânia, Brazil
| | - João Batista de Souza
- Department of Prevention and Oral Rehabilitation, School of Dentistry, University of Goiás, Goiânia, Brazil
| | - Pascal Magne
- The Don & Sybil Harrington Professor of Esthetic Dentistry, Division of Restorative Sciences, Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
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Cesca R, Colombo V, Ernst B, Gallo LM, Özcan M. Tensile Strength and Failure Types of Direct and Indirect Resin Composite Copings for Perio-Overdentures Luted Using Different Adhesive Cementation Modalities. MATERIALS 2020; 13:ma13163517. [PMID: 32784945 PMCID: PMC7475840 DOI: 10.3390/ma13163517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 11/24/2022]
Abstract
Perio-overdenture design helps to reduce periodontal diseases and secondary caries on abutment teeth. Composite copings can be cemented adhesively to the abutment teeth with different techniques. In this study, direct/indirect resin composite copings for perio-overdentures, luted using different adhesive cementation modalities were compared. Human teeth (N = 40) were prepared to receive spherical attachment copings and randomly divided into four groups: (1) resin-composite copings bonded directly (DC), (2) composite copings made indirectly, luted with dual-polymerized resin cement (ICV), (3) composite copings made indirectly, bonded with resin composite (ICT), (4) composite copings made indirectly, bonded with resin composite after the immediate dentin sealing method (IDS). Specimens were tested for tensile failure and one-way ANOVA (alpha = 0.05) was performed and the two-parameter Weibull modulus, scale (m) and shape (0) were calculated. Mean tensile load (N) was significantly higher for Group IDS (238 ± 81) than for the other groups (144 ± 53–184 ± 46) (p < 0.05). Group IDS (0.54 ± 0.25 mm) showed significantly higher deformation (mm) than other groups (0.2 ± 0.1–0.32 ± 0.15) (p < 0.05). Weibull distribution presented lower shape (0) for DC (3.33) compared to other groups (3.57–4.99). Cohesive coping failures were more frequent in Group IDS (60%) and mixed failures in other groups (40–60%). In conclusion, IDS copings could be preferred over other fabrication and adhesion modalities.
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Affiliation(s)
- Raffaele Cesca
- Laboratory of Physiology and Biomechanics of the Masticatory System, Clinic for Masticatory Disorders, Center for Dental and Oral Medicine, University of Zurich, 8032 Zurich, Switzerland; (R.C.); (V.C.); (L.M.G.)
| | - Vera Colombo
- Laboratory of Physiology and Biomechanics of the Masticatory System, Clinic for Masticatory Disorders, Center for Dental and Oral Medicine, University of Zurich, 8032 Zurich, Switzerland; (R.C.); (V.C.); (L.M.G.)
| | - Bruna Ernst
- Clinic for Reconstructive Dentistry, Division of Dental Biomaterials, Center for Dental and Oral Medicine, University of Zürich, 8032 Zurich, Switzerland;
| | - Luigi Maria Gallo
- Laboratory of Physiology and Biomechanics of the Masticatory System, Clinic for Masticatory Disorders, Center for Dental and Oral Medicine, University of Zurich, 8032 Zurich, Switzerland; (R.C.); (V.C.); (L.M.G.)
| | - Mutlu Özcan
- Clinic for Reconstructive Dentistry, Division of Dental Biomaterials, Center for Dental and Oral Medicine, University of Zürich, 8032 Zurich, Switzerland;
- Correspondence: ; Tel.: +41-44-634-3251; Fax: +41-44-634-4305
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PEREIRA RP, CECCATO Y, MONTEIRO JÚNIOR S, GONDO R. Influência do selamento dentinário imediato com sistema adesivo universal na resistência de união. REVISTA DE ODONTOLOGIA DA UNESP 2020. [DOI: 10.1590/1807-2577.07120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução O selamento dentinário imediato consiste na aplicação imediata de um sistema adesivo sobre exposições dentinárias após o preparo dental e previamente aos procedimentos de moldagem. Objetivo O objetivo do estudo foi avaliar a influência do selamento dentinário imediato (SDI) na resistência adesiva do sistema adesivo universal (Single Bond Universal, 3M ESPE) em dentina, na forma de aplicação autocondicionante. Material e método 30 incisivos bovinos foram divididos em 3 grupos (n = 10): grupo S (Sem Selamento Dentinário Imediato), grupo SDI (Selamento Dentinário Imediato) e grupo SDIF (Selamento Dentinário Imediato + Resina Flow). A superfície vestibular foi desgastada com pontas diamantadas até a exposição superficial de dentina. A simulação da lama dentinária foi realizada com lixa d’água por 30s e a dentina tratada de acordo com o respectivo grupo. Para simulação da restauração provisória, foram cimentados blocos de resina bisacrílica com cimento de óxido de zinco. Após 7 dias, foi realizada a cimentação definitiva de blocos de resina com cimento resinoso dual (RelyX ARC, 3M ESPE). Os espécimes foram seccionados para obtenção de filetes de 1mm2 e submetidos ao teste de microtração, em uma máquina universal de ensaios (Instron). Os resultados foram tabulados e submetidos a Análise de Variância (ANOVA) e teste de Tukey a 5% de significância. Resultado Observaram-se maiores valores de resistência de união para o grupo SDIF (23,53 MPa), diferindo estatisticamente do Grupo S (17,65 MPa) (p=0,008). O grupo SDI apresentou valor médio de resistência de união (19,25 MPa), não diferindo estatisticamente dos grupos S (p=0,68) e SDIF (p=0,07). Conclusão Recomenda-se a técnica de selamento dentinário imediato seguido da uma camada de resina flow, em exposições dentinárias ocasionadas pelo preparo dental para restaurações indiretas.
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